Comparative Analysis of Telecytology Versus In-Person Rapid On-Site Evaluation for Fine Needle Aspiration (FNA) Specimens: Insights from a Single Institutional Study

Summary: Abstract: Background: Fine needle aspiration (FNA) has become increasingly popular for diagnoses of various conditions as they are minimally invasive and cost-effective. Rapid on-site evaluation (ROSE) of FNA biopsies ensures appropriate specimen triage to guide the next steps for diagnosis (biomarkers, flow cytometry, or other ancillary studies). With the increase in locations where FNAs are performed at our institution, there was an increased demand for cytopathologists at these sites for ROSE. This high demand generated the need for an alternative way to evaluate specimens remotely, such as by telecytology (TC). Remote ROSE of FNA specimens saves time and costs while increasing productivity. However, many centers are not optimizing its use despite availability. Objective: This study compares the accuracy of our institution's ROSE performed in-person versus TC. Methods: A retrospective study of FNA cytology conducted at our institution across three locations from Jan 1st, 2022, to Dec 31st, 2023, was performed. (Table 1). Data including the specimen source, ROSE in person or by TC, ROSE interpretation, final cytology diagnosis, and ancillary tests used for diagnosis were collected from electronic medical records. Cases excluded from the analysis included those without ROSE or those with only adequacy assessment. The concordance between ROSE interpretations and final diagnoses across six categories was determined for both ROSE in person and ROSE by TC, and the diagnostic accuracy between both were compared. Design: 2,343 FNA’s were performed during the two years. ROSE was utilized in 1,731 cases (61%), with 1252 (72%), 300 (17%), and 179 (10%) occurring at locations 1, 2, and 3, respectively. In-person ROSE accounted for 1490 (86%) of these cases, while TC was used in 241 (14%). Conclusion: Overall diagnostic accuracy for in-person ROSE in 1459 cases was 71% across all diagnostic categories, with 99% accuracy for malignant neoplasms. Major discrepancies were very low (benign –malignant and vice versa) were 3% for in-person and 5% for TC. For the 238 cases with ROSE by TC, diagnostic accuracy was 56% across all diagnostic categories, with major discrepancies of 5%. There was no difference observed in TC performance based on the location.